System, Apparatus, and Methods for Developing and Delivering Health Information

ABSTRACT

An individual is enabled to develop medical contingency plans that are automatically activated if the individual is rendered unable to assert his or her own will by an injury or a medical condition. Medical information and health information are assembled and advance directives are formulated in a manner that combines systematic guidance to optimize contingency plan effectiveness and individual autonomy to permit individuals to design their own plan. When a participating individual is rendered unable to assert his or her own will by an injury or medical emergency, identification information and instructions carried by the individual enable responding care givers to access enforceable documents that direct medical care and address personal needs. The documents produced are designed to overcome mitigating factors associated with the urgency of the individual&#39;s condition, institutional policy, conflicting family member opinions, information transmission difficulties, the attitudes of treating physicians, language discrepancies, and the governmental rules in effect where the emergency happens.

This continuation application claims the benefit and priority of U.S.patent application Ser. No. 09/616,472, filed on Jul. 14, 2000, which inturn claims the benefit and priority of provisional application No.60/143,960, filed on Jul. 15, 1999, both of which are herebyincorporated by reference in their entirety.

BACKGROUND OF THE INVENTION

This invention relates to the assemblage, storage, and distribution ofcomputerized medical records and advance directives. The possibility ofemergencies, especially medical emergencies, is normally discussedwithin the family circle. Rules are set about what treatments to pursueor what to avoid, what lifestyle to lead and what behaviors to stay awayfrom. However, having arrived at decisions on how to deal with theseemergencies, implementation of a plan is often impeded because medicalinformation and directives are dispersed and inaccessible. Also,individuals generally do not have the experience required to ensure thattheir decisions are able to withstand the pressures of urgency,institutional policy, conflicting family member opinions, informationtransmission difficulties, the attitudes of treating physicians,language discrepancies, and the governmental rules in effect where theemergency happens.

When medical information is collected and advance directives are inplace, there is no guarantee that the information will be communicatedto, available to, or honored by physicians. There are no requirementsthat doctors inquire or be informed about decisions made by participantsconcerning care at the end of life. Doctors may distrust a document thatpurports to dictate the best course to follow in the inherently complexworld of medical care at the end of life. They may have found thedocuments they have examined previously to be too narrow or drafted fora location having different legal requirements for such documents. Theymay have been furnished with ambiguous or unreadable documents on prioroccasions. The original document may be unavailable and they may bedistrustful of copies, fearing the original may have been revoked.

Even when directives are communicated and honored, the lack ofaccessible and centralized medical information may contribute to errorsin implementation of directives and in the provision of medical care.Medication-related errors occur frequently in hospitals and, althoughnot all result in actual harm, those that do, are costly. The cause ofmany preventable errors can be traced to faulty systems.

When advance directives are duly carried out, their effectiveness islimited by the quality of the information underlying an individual'scontingency planning. Although a contingency medical plan is a personalmatter, it should be developed in the light of specialized knowledgethat is generally inaccessible to lay persons because of the prohibitivecosts associated with consulting medical specialists. There is presentlyno way for an individual to bring the benefit of advanced studies intohis personal plan for care in anticipation of an illness or injury.Similarly, there is a need to provide individuals with the ability tomake choices about emergency and end of life planning that are informedby knowledge of the best protocols available to medical personnel.

Therefore, it would be desirable to provide individuals with the abilityto be fully prepared for medical emergencies and medical care at the endof their lives.

It would also be desirable to provide individuals with the ability toformulate contingency plans and advance directives that address theproblems that arise due to the urgency surrounding implementation of aplan under critical conditions, institutional resistance, conflictingfamily member opinions, information transmission difficulties, theattitudes of treating physicians, language discrepancies, and thegovernmental rules in effect where the emergency happens.

Additionally, it would be desirable to provide individuals withcontingency plans and advance directives that will be communicated to,available to, and honored by physicians.

It would be further desirable to provide individuals with contingencyplans and advance directives that have reduced errors.

Moreover, it would be desirable to provide individuals with the abilityto formulate contingency plans and advance directives that are informedby advanced medical knowledge.

SUMMARY OF THE INVENTION

Therefore, it is an object of the invention to provide individuals withthe ability to be fully prepared for medical emergencies and medicalcare at the end of their lives.

It is also an object of the invention to provide individuals with theability to formulate contingency plans and advance directives that are“effective.” To be effective, a plan must address the problems thatarise due to the urgency surrounding implementation of a plan undercritical conditions, institutional resistance, conflicting family memberopinions, information transmission difficulties, the attitudes oftreating physicians, language discrepancies, and the governmental rulesin effect where the emergency happens.

Additionally, it is an object of the invention to provide individualswith contingency plans and advance directives that will be communicatedto, available to, and honored by physicians.

It is a further object of the invention to provide individuals withcontingency plans and advance directives that have reduced errors.

Moreover, it is an object of the invention to provide individuals withthe ability to formulate contingency plans and advance directives thatare informed by advanced medical knowledge.

In accordance with the present invention systems, apparatus, and methodsare provided for enabling “participants” to effect and implement choicesabout their medical care and contingency plans should they be renderedunable to assert their own will. A “participant” is an individual whosecontingency plan or advance directive is formulated and registeredaccording to the principles of the invention.

In one embodiment of the invention, a computer-based system is providedfor receiving, storing, and communicating information necessary toimplement personally designed contingency plans. Each participant hascontrol over end-of-life information that is accessibly stored in aninformation set in an information storage registry.

A participant inputs or designates instructions to the system fortransmitting information products based on the end-of-life informationstored in his information set. The participant carries identifyinginformation that can be used, in the event of emergency, by a respondingcare giver to activate the system and cause information productscontaining health information and directives to be forwarded todesignated persons.

The system includes an information input guide and a referenceinformation interface to improve the effectiveness of the information aparticipant inputs, an information storage registry for storing theinformation, an information product producer to assemble informationproducts from the stored information, and an information product requestprocessor for responding to requests from care givers and dispatchinginformation products. Additionally, the system is equipped with aninformation input interface and an information output interface forenabling users to utilize a wide range of telecommunication devices forexchanging information.

BRIEF DESCRIPTION OF THE DRAWINGS

The above and other objects and advantages of the invention will beapparent upon consideration of the following detailed description, takenin conjunction with the accompanying figures in which:

FIG. 1 is a partial overview of the invention;

FIG. 2 is a partial overview of an information set;

FIG. 3 is a partial overview of administrative information;

FIG. 4 is a partial overview of end-of-life information;

FIG. 5 is a partial overview of end-of-life choices;

FIG. 6 is a partial overview of advance directives;

FIG. 7 is a partial overview of information input interface devices;

FIG. 8 is a partial overview of information products;

FIG. 9 is a partial overview of information output interface devices;

FIG. 10 is a partial overview of key persons suggested by an informationinput guide;

FIG. 11 is a partial overview of key institutions suggested by aninformation input guide;

FIG. 12 is a partial overview of end-of-life conditions presented by aninformation input guide;

FIG. 13 is a partial overview of end-of-life condition responsespresented by an information input guide;

FIG. 14 is a partial overview of formats used by an information storageregistry; and

FIG. 15 is a partial overview of the features on a reference informationinterface.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

The following terms as used herein have the meanings as follows:

Participant: a person using the present invention to anticipate, store,and effect choices, directives, and other orders and desires concerningtheir own medical, emergency, health, or other care.

Incapacitated: a condition in which a person is nonresponsive,incommunicative, or unable to act, deliberate, choose, or otherwiseassert his will independently or for himself.

End of life: a situation or condition encountered by a participant whilestill living in which a participant is incapacitated, whether or not theparticipant's life is about to end.

End of life information: includes the information, choices, documents,and responses necessary to direct the care of a participant in spite ofhis incapacitated state.

Advance directive: a participant's selection or refusal of medicaltreatment in response to an incapacitating condition, a selection of aspecific response to a given incapacitating condition, and documentsembodying such directives such as a medical power of attorney, a livingwill, or other information product of the present invention.

Information product: comprises instructions and necessary supportinginformation to effect the advance directives or other desired responseof a participant to an incapacitating condition, including replicates ofraw data, such as an x-ray or a page of a medical record, provided aspart of end-of-life information; copies of legal documents relating tocare of the participant developed independently of the present inventionand provided on behalf of the participant as part of end-of-lifeinformation (e.g., a living will prepared by the participant's personalattorney); a copy of a submittable document generated by the system inan interactive session with an input user, transmitted to the user or akey person for execution, and finally received by the service component;and additional instructions or “packaging” to accompany any of theforegoing; and a summary of any of the foregoing.

Input user: a person who may be acting for himself as a participant oras an agent of a participant that inputs end-of-life information intothe system.

Output recipient—a person receiving an information product from thesystem, including the person requesting information from the system, acare giver or agent of a care-giving institution, key persons andinstitutions.

In a preferred embodiment, the invention is a system for providing aplurality of participants with the ability to anticipate, store, andeffect choices, directives, and other orders and desires concerningtheir own medical, emergency, health, or other care should they berendered unable to deliberate or act for themselves. A participant whois unable to act or deliberate for himself will herein be referred to asan unresponsive participant. It will be understood, however, that anyreference to a participant who requires care according to the principlesof this invention is impliedly in an unresponsive state.

The system has a service component for receiving and storing end-of-lifeinformation and producing and exporting information products in theevent of an end-of-life condition.

End-of-life information includes, but is not limited to, the informationnecessary to direct the care of a participant in spite of hisincapacitated state. The response to the occurrence of an end-of-lifecondition is referred to as an end-of-life condition response. Anend-of-life condition response includes, but is not limited to, medicaltreatment.

It will be understood that “end-of-life” as used herein will not belimited to information, choices, documents, situations, conditions, andresponses related to a situation in which an unresponsive participant'slife is likely to end, but will also refer to those choices, documents,situations, conditions, and responses in which a participant's life mayor may not be likely to end, but in which a participant lacks theability to act, deliberate, communicate, choose, or otherwise assert hiswill independently or for himself. It will be further understood thateven when a participant is able to act for himself, he can access thesystem to obtain information and information products for hisconvenience.

A system user, who may be acting for himself as a participant or as anagent of a participant inputs end-of-life information into the servicecomponent. End-of-life information includes copies of raw data such asscanned-in directives, forms, documents, medical images, and laboratoryresults. End-of-life information also includes electives issued by auser of the system. Electives include elections of information products,types of information products, or characteristics of informationproducts that the system can produce or forward for the participant inthe event of an end-of-life condition. Elections also includeprospective recipients of documents and choices of conditions fortriggering the transmission of the information products. Preferably, theuser makes elections, via an interactive user interface. Electivedocuments are thus producible, available, and transmittable in the eventthat an end-of-life condition arises. End-of-life information is storedin an information set corresponding to a particular participant.

Each information set preferably also includes administrative informationthat may include participant particulars, privacy information, billinginformation, security information, and privacy information.

The scope of end-of-life information is designed to anticipate themedical, ethical, legal, bureaucratic, emotional, and practical needs ofparticipants and to ensure that any person delivering care to theparticipant in response to an end-of-life condition has at his disposalall the information and legal documentation necessary to effect anend-of-life condition response according to the desires of theparticipant despite the participant's inability to communicate or asserthis will.

End-of-life information preferably further includes enforcementinformation to ensure enforcement of the participants wishes in anygiven jurisdiction or in a location in which English is not the officialor primary language. Accordingly, the service component is able toproduce end-of-life information products that are tailored to meet therequirements of any given jurisdiction, both domestic and foreign. Theservice component also is able to produce information products writtenin non-English languages to enhance legal force in foreign countries.

The system preferably also includes an input interface through which auser, such as an input user, may interact with the service component.The primary function of the input interface is to convey informationfrom an input user to the service component, but the input interface mayalso have output capability to facilitate the receipt of various formsof information from the input user.

The input interface allows the service component to receive informationfrom the input user in a wide range of formats. For example, the inputinterface may convey a hardcopy form by conventional means, but may alsoconvey data electronically and through wireless means.

The service component preferably includes an information productproducer. The information product producer generates documents that aredesigned to communicate the participant's orders to a care giver in alegally binding form. The information product producer utilizesend-of-life information stored in the participant's information set togenerate an information product. In one preferred embodiment, theinformation set is stored in a database and the information productproducer has word processing functions that interact with the data baseto incorporate stored data into information products suitable foroutput.

Information products may be replicates of raw data, such as an x-ray ora page of a medical record, stored in the information set. Raw data maybe forwarded as an information product in substantially the same form inwhich it was input or it may be forwarded with “packaging” to make itconform to a particular information product format. Alternatively, aninformation product may be a computer-generated document or summary of adocument. An information product may also be a copy of a submittabledocument generated by the service component in an interactive sessionwith an input user, transmitted to the user or a key person forexecution, and finally received by the service component. A copy of thesigned document would then be stored in the information set untilconditions for its transmission are fulfilled.

The invention preferably includes an output interface for enabling anoutput user, who may be a professional care giver or a responding layperson, to activate the invention in response to an end-of-lifecondition of a participant. One function of the output interface is toconvey one or more information products to an output recipient. Outputrecipients include the output user, for example a care giver or agent ofa care giving institution, and additional output recipients such as keypersons and institutions. Key persons include, but are not limited to,family members, counselors, and medical personnel. Key institutionsinclude, but are not limited to, hospitals, hospices, retirement homes,and health care management organizations. It will be understood that keypersons and key institutions are preferably designated by the input userand that any person or institution designated by the input user may beconsidered a key person or key institution, respectively. Furthermore,references herein to key institutions will include the personnel oragents of those institutions.

The invention preferably provides the input user with the ability todesignate certain key persons and institutions as output recipients towhom an information product should be transmitted in case of a specifiedevent. The specified event may be defined in specific terms such as thearrival of a certain date or it may defined in more general terms suchas the activation of the system by an output user in response to theoccurrence of an end-of-life condition. The transmission of aninformation product to an output recipient may be done automatically andwithout knowledge of an output user.

The information output interface is able to convey information productsto output recipients through a variety of channels and in a variety offorms. The forms include, but are not limited to, documents (which mayor may not be electronic documents) and data streams (includingelectronic, electromagnetic, and optical data streams).

The service component also includes an information input guide. Theinformation input guide provides information to an output user, a keyperson, or a key institution. Information from the information inputguide is designed to educate the input user and key persons andinstitutions about the features of the invention, the issues that arisewhen a participant uses the invention, and the issues that arise whenthe invention is activated by an output user on behalf of anunresponsive participant. The issues are informed by knowledge of theprocess of effecting choices during an end-of-life condition.Information from the input information guide helps a participant makechoices about end-of-life information and store end-of-life informationthat will most effectively and expediently compel and facilitatefulfillment of the participant's end-of-life plan.

The information input guide preferably includes a broad description ofend-of-life plans in general, including suggestions of key persons andinstitutions that a participant may engage in the end-of-life planningprocess. The information input guide preferably further provideseducational information and outlines of planning strategies that areappropriate for participants of different age, religion, culturalbackground, and family structure. The end-of-life planning informationand strategies preferably further include suggestions for non-medicalend-of-life information such as personal messages that a participantwishes to have delivered in the form of an information product to a keyperson, such as a close friend or family member, in the event that anend-of-life condition arises.

The information input guide preferably has an interactive interface forcommunicating with an input user. The input guide preferably allows theinput user to choose forms (such as an election form indicating a set ofservices, information products, or end-of-life condition responses thatthe participant desires) and submittable documents (including, forexample, executable documents such as a Do Not Resuscitate Order or anOrgan Donation Authorization) that the input user, participant, or keyperson completes or signs and then submits to the service component viathe input interface. The service component then scans the hardcopy formor document and stores it in the participant's information set,preferably in a storage registry that is discussed in greater detailbelow.

In particular, the information input guide provides the input user witha series of commonly encountered end-of-life conditions, such aspermanent unconsciousness, and corresponding options for end-of-lifecondition responses, including, but not limited to, medical treatment,supplying some form of intravenous nutrition, and discontinuation oflife support.

Preferably, end-of-life information, encapsulated in an information setcorresponding to a given participant, is stored in an informationstorage registry. The information storage registry stores information instandard form, such as structured arrays or tables of end-of-lifeinformation, including elections, that are efficiently stored in astructured format. The storage registry also stores information in anon-standard format. The non-standard format provides the versatilityneeded to store medical images and scanned-in copies of medical recordsor executed documents. The storage registry also stores administrativeinformation that is part of the information set corresponding to theparticipant.

End-of-life information may be stored in an electronically orelectromagnetically readable format, an optically readable format, or inany other appropriate format.

Preferably, the service component also includes an interface foraccessing reference information. Reference information includes, but isnot limited to, guidelines for medical practice and medical protocolsrelevant to end-of-life conditions. Reference information may alsoinclude an electronic medical record corresponding to the participant.One guideline is a physician's practice management program. Access toreference information provides input users with information available tothe medical community and helps participants make more informeddecisions and guides them toward including end-of-life information thatwill ensure more effective care and fulfillment of their will inresponse to end-of-life conditions.

The reference information interface preferably also provides access totools for analysis of end-of-life information that resides in aninformation set in the service component. The analysis tools, like thereference information, allow participants to make informed choices aboutthe end-of-life information they submit to the system. The analysistools allow an input user to obtain qualitative and quantitativeinformation about specific medical conditions and correspondingtreatments (including end-of-life condition responses) that are relevantto the participant.

Accordingly, the input user is provided with a measurement of an outcomefor a given treatment or end-of-life condition response based onknowledge from medical research. Similarly, an analysis tool of thereference information interface may provide a prediction of an outcomefor an end-of-life condition response. An analysis tool may also providea comparison between the effects of different end-of-life conditionresponses in connection with a given end-of-life condition.

In particular, the analysis tool preferably can emphasize the importanceof choosing end-of-life information prudently by illustrating thedifference between the outcomes of a desired end-of-life conditionresponse and an undesired end-of-life condition response in anunfortunate case where an individual did not have the benefit of aneffective end-of-life planning system. Treatment comparison has specialrelevance to choices about acceptance of organ donation.

Additionally, the reference information interface analysis toolspreferably provide the input user with current information about druginteractions, and interrelationships between different diseases andinjuries to help the participant improve the quality and relevance ofthe end-of-life information that is submitted to the invention.

The reference information interface preferably also serves the medicalresearch community by permitting analysis of end-of-life informationcontained in information sets corresponding to participants. Inparticular, the medical research community may be provided withstatistics about the choices that individuals make, the importance ofresponding to the desires of those individuals, and information that canhelp care givers learn how to better serve the needs of individuals whohave developed an end-of-life plan. It will be appreciated that externalanalysis of end-of-life information may be conducted via channels otherthan the reference information interface. For example, an authorizedresearcher may be provided access to end-of-life information by aspecialized research interface or module.

It will be understood that the reference information interface andassociated interface for analysis tools anticipate the continueddevelopment of new reference information and analysis tools. Theinvention contemplates providing access to new information and analysistools as they become available.

Preferably, the invention also includes an information product requestprocessor. The information product request processor receives requests,via the information output interface from an output user. A participantis preferably provided with an identification instrument which may be inthe form of an identification card or a smart card. If an end-of-lifecondition arises, an individual who comes to the aid of the unresponsiveparticipant, provides care or treatment to the unresponsive participant,or is involved in responding to the end-of-life condition, is instructedby the identification instrument to access the output informationinterface. The identification instrument provides identificationinformation and security information that the attending individual canuse to access and obtain the information products generated inaccordance with the end-of-life information and the end-of-life planchosen by the participant.

Preferably, in response to activation of the system by an output user,information products may be transmitted to any output recipientpreviously specified by an input user, to the output user himself, or tooutput recipients that the output user may designate. Additionally, ifthe participant has not done so already, the output user may designate aparticular language or jurisdiction relevant to the geographic locationin which an end-of-life condition response is to be implemented for thenon-responsive unresponsive participant. Translations of summaries andof portions of information products based on standard end-of-lifeinformation may be produced by the use of translation software, by ahuman translator, by a combination thereof, or by any other means. Sincenon-standard information may be entered into the information storageregistry, imaged copies of documents of any kind and in any language maybe stored for later transmission.

In another preferred embodiment the invention is provided as anapparatus for providing participants with the ability to effect choicesabout their care should they become unresponsive. The apparatus includesmemory equipment for storing at least one information set correspondingto each participant and data processing equipment for performing thefunctions of information input guide, reference information interface,information product producer, and information product request processor.

The apparatus preferably also includes input equipment for allowing aninput user corresponding to a given participant to input end-of-lifeinformation (both raw data and elections). Additionally, the apparatuspreferably includes output equipment for enabling an output user torequest an information product that is produced from the end-of-lifeinformation contained in the participant's information set.

The following hypothetical illustration demonstrates some of thefeatures of the invention. The illustration concerns a 53-year old womanand her 81-year old widowed mother (participant) residing in the UnitedStates.

The participant's medical records were scattered among a number ofprimary care physicians, medical specialists, hospitals, andlaboratories because she had lived in several different localities. Overthe years, the participant acquired indemnity insurance, Medicare HMOcoverage, and, later, regular Medicare benefits. The participant hademphysema in its early or middle stages.

The participant's mental condition was excellent and she desired to notbecome a burden to her children at any time preceding her death. Theparticipant indicated that she wished to discuss end-of-life informationproducts with key persons such as her physician, a lawyer, and herdaughter. She also planned to visit her son in Austria, a prospectiveenforcement jurisdiction. Her daughter agreed to go with her and toassist her mother with end-of-life planning and other preliminaryarrangements regarding health as well as travel. These arrangementswould be completed by using the present invention.

During the course of her visit to Austria, the participant experiencedan end-of-life condition. The participant stopped breathing, sufferedbrain damage, fell into a coma, was placed on life support (an undesiredend-of-life condition response), and died in the presence of two of herchildren after life support was removed. The removal of life support wasa desired end-of-life condition response corresponding to an end-of-lifechoice that she had chosen and registered according to the principles ofthe invention. The desired end-of-life condition response was attainedonly through overcoming the resistance of attending care givers usingthis invention.

Using this invention the participant and her daughter acted as followsbefore and during the participant's trip:

Initial Search for Information.

At the participants' request, the daughter made a search of the Internetand found a web site that used this invention. The invention providedthe daughter provided with the following resources:

(1) explanations about medical care in emergencies, especially thoseoccurring while traveling, and at the end of life (information inputguide), (2) the ability to prepare drafts of health care documentsonline so that her mother can sign them after discussing them with herdoctor and a lawyer (information input guide), and (3) informationstorage registry for the documents that her mother signed so that theywould be available at all times and in all places (service componentfunctions, as described above).

In this illustration, the daughter did not complete a worksheet at theweb site so as to prepare and print documents, but instead downloadedthe worksheet in order for her mother to make decisions later.

Compilation of Emergency Health Information (a Category of End-of-LifeInformation).

The needed emergency information consisted of important medicalconditions such as emphysema, prescriptions, insurance coverage, and thenames and telephone numbers of key persons who would also become outputrecipients, such as doctors and other persons to contact. Theparticipant and her daughter were able to compile the information andlist it on the worksheet that the daughter had downloaded from theInternet for later entry and storage of information in the informationstorage registry.

Compilation of Other Health Information.

The participant caused non-emergency information to be transmitted tothe registry before her trip to Austria. Her physician's x-rayidentifying her condition of emphysema was transmitted to the registryso that it could be stored there.

Storage of Emergency Health Information in the Registry.

The daughter made a second visit to the Internet, this time to enteremergency health information concerning the participant. A writtenstatement of that information was produced by the service component forverification. The daughter was advised that a signature on the documentwould be accepted but was not required for storage of emergency healthinformation in the database. The daughter printed a letter-sized sheetcontaining an identification instrument. Identification instrumentsinclude, but are not limited to, wallet-sized print-outs, plastic cards,and smartcards. The identification instrument showed the participant'sname, gender, Social Security Number, personal identification number, atoll-free number for obtaining the information stored in the database,and the Internet address of the registry. The daughter was also advisedthat the same information would be contained on a plastic card of thesame size that would be sent later to her mother. Finally, the daughterwas told that the entirety of the emergency health information would beplaced on her mother's personal data assistant or smart card if she hadone that was compatible with the registry's software and if there wassufficient storage space remaining on it.

Storage of Other Health Information in the Registry.

In this illustration, other health information was transmitted by adoctor's office to the service component by automated interface overtelephone lines. Minimal effort was required on the part of the doctor'sstaff. The staff was required to keypunch only the participant's name,gender, Social Security number, personal identification number, and theidentification of the type (lab analysis, x-ray, and so forth) and thedate of the record. If the doctor's office had had the necessaryequipment and the participant a smart card, the only keypunching wouldhave been of the type and date of the record.

Testing Emergency Health Information for Medical Errors.

Using the reference information interface and associated analysis tools,the service component tested medical conditions and prescriptions formedical complications and errors. If it found that participant wastaking a prescription for one condition that aggravated another, or thatwas incompatible with another prescription, an alert would have beensent to the participant and her doctor. In this case, no possiblyadverse drug reaction was found.

Discussions about End-of-Life Medical Care.

Pamphlets concerning end-of-life planning were downloaded from the website and formed a basis for discussions among participant, daughter,doctor, and lawyer. The doctor advised that a Do-Not-Resuscitate Orderwas inappropriate because the participant's emphysema was serious butnot grave. The participant decided that she wanted to make a donation ofher corneas, which were in good condition, and to authorize her daughterto make medical decisions for her, including the withdrawal of lifesupport, should she become incapacitated.

Independent Legal Advice about Use of Advance Directives.

The participant discussed the alternatives available in signing advancedirectives with a lawyer located by her daughter, and decided to use ahealth care power of attorney and organ donation form associated withthis invention, rather than the documents available from other sources.The service component of this invention can accommodate images ofdocuments from other sources but the participant chose to usecomprehensive documents generated by the information product producer ofthis invention because they can be transmitted in summary form.Summaries are more likely to be read by a physician under the stress ofcaring for a participant experiencing an end-of-life condition.

Preparation of Advance Directives.

During the daughter's third visit to the Internet, she made electionsthat the participant had made concerning end-of-life condition responsesand donation of her corneas. The daughter then printed the relevantdocuments. A health care power of attorney stated that the daughter wasauthorized to determine when, but not whether, life support of any typemust be refused or discontinued should the participant be in the finalstages of any form of terminal condition, including permanentunconsciousness. The documents were then signed in the presence ofwitnesses and sent to the service component for scanning and indexing.

Transmission of Emergency Health Information and Summaries of Documentswhen Needed.

The participant traveled to Austria and both the emergency healthinformation and summaries of the health care power of attorney and organdonation were needed when the participant's end-of-life conditionoccurred. The participant stopped breathing and suffered brain damage.The most convenient method of access to the service component was theInternet, rather telephone, followed by a fax. Emergency personnel at ahospital in Salzburg, Austria became output users and output recipients.Having German as a primary language, they requested online thatinformation products be transmitted with German as the informationproduct language.

Transmission of Other Health Information.

The x-ray was available as non-emergency end-of-life information and wastransmitted over telephone lines to the Salzburg hospital's computerwhere it could be read. In view of the damage to the participant'sbrain, the x-ray's chief value was to confirm that her lungs were soweak that she would need permanent connection to a ventilator.

Implementation of the Participant's Instructions Concerning Medical Careat the End of Life.

The information products (viz., summaries of the health care power ofattorney and the organ donation form) were specific about thelife-prolonging treatment to be administered to the participant and hergift of corneas. They were in the primary language, German, spoken bythe doctors and hospital staff. Nevertheless, it took time andpersuasion to accomplish the participant's objectives.

The health care power of attorney gave the daughter alone authority toact for the participant, but the participant's son living in Austria andanother child residing in the United States were irritated about theirlack of decision-making power. To overcome the familial resistance, itwas necessary to produce additional information products—namely, imagesof the documents bearing the participant's signature (residing in theparticipant's information set as end-of-life information) as well as thesummaries of them produced by the information product producer. Bothdocuments stated that summaries and images had the same effect as theoriginals. Nevertheless, the daughter, as an authorized output user,requested and received from the service component registry faxtransmission of images of the two documents signed by her mother, theparticipant.

The daughter also requested and received from the information productrequest processor full-text translations of the health care power ofattorney and corresponding summary because the daughter anticipated thatthe hospital's administration and attorneys would demand them inaddition to the summaries in German. Ultimately, Austrian lawyersconcluded that Austrian courts would recognize such documents signed inthe U.S. by an American in spite of a prevalent cultural prejudiceagainst advance directives in Austria.

In this illustration the invention overcame bureaucratic, cultural andfamilial resistance to the use of advance directives. The informationproducts produced by the invention effected an acceptance of theparticipant's desire to have life support systems withdrawn.

The Organ Donation.

Several European countries presume that all usable organs are intendedto be donated unless the participant has made a written statement to thecontrary. National and European registries are maintained so thatobjections can be stated and accessed. The participant's written refusalto donate other organs, and its placement in the storage registryassociated with this invention, asserted her lawful objection to donateother organs, but enabled the donation of the corneas.

Benefits for Medicine.

The daughter was aware that the registry accepted information about whatactually happened to participants in emergencies and at the end of lifeso that outcomes could be measured, predictive models developed, andmedical protocols refined. She, therefore, returned to the Internet andanswered questions posed by researchers to assist in developing bettermedical practices.

Preferred embodiments of the invention will now be described withreference to the figures.

FIG. 1 shows an overview of system 100 of the invention. The inventioncenters around service component 102. Information input guide 104 oninput side 101 of service component 102 provides guidance information106 to input user 108. Input user 108 may be the same person asparticipant 110 or may be an authorized or appointed agent ofparticipant 110. Input user 108 accesses service component 102 bylogging on to system 100 through information input interface 112. Inputuser 108 transmits end-of-life information 114 to service component 102via information interface 112. Information input guide 104 may supplyinput user 108 with input form 116 for subsequent submission to servicecomponent 102. Input form 116 may be an executable document scripted byservice component 102. Alternatively, input form 116 may be an electionworksheet for user 108 to indicate end-of-life information elections.End-of-life information 114 is then stored in information set 118 ininformation storage registry 120. Information storage registry 120contains a plurality of information sets 118, each corresponding to aparticipant such as participant 110.

Reference information interface 122 provides reference information andaccess to analysis tools to input user 108 (arrow A) to assist inputuser 108 in making decisions regarding end-of-life planning that areinformed by current medical knowledge. Reference information interface122 also may provide medical researchers with access to end-of-lifeinformation in participant information sets (arrow B) to assist inmedical research in the area of end-of-life condition response andtreatment.

Output side 103 of service component 102 features information productrequest processor 124 for receiving requests 126 from output user 128via information output interface 130. Output user 128 responds to anend-of-life condition in participant 110 by logging on to system 100through information output interface 130 and issues a request toinformation product request processor 124 for one or more informationproducts. Information request processor 124 issues information productrequest 132 to information product producer 134. Information productproducer 134 accesses information set 118 (arrow C) corresponding toparticipant 110. (Output user 128 supplies participant identificationinformation furnished by an identification instrument preferably carriedby participant 110.)

End-of-life information 116, stored in information storage registry 120,includes both raw data 200 and end-of-life elections 202 (see FIG. 2).Information product producer 134 can capture raw data 200 fortransmission to output recipient 140 as information product 136. Outputrecipient 140 will in most cases be identical to output user 128, butalso may be a key person 146 or a member of a key institution 148.

Alternatively or additionally, information product producer 134 utilizesan election 202 to produce an information product 138 that is astandardized document (such as a form or a form letter) or a summary ofa document. Information products 136 and 138 are preferably used inconjunction with each other to effect the choices of participant 110through the actions of output user 128.

Service component 102 preferably also directs information products 136and 138 to additional output recipient 142. The transmission ofinformation products 136 and 138 to additional output recipient 142 maybe predetermined by a request of participant 110 in accordance withend-of-life information 116.

FIG. 2 shows the basic contents of information set 118. Information set118 includes both end-of-life information 116 and administrativeinformation 204. End-of-life information includes raw data 200. Raw data200 include any image, such as a medical image, or document, such as alaboratory report or legal document, that is stored as an image. Rawdata 200 are preferably scanned-in or received electronically. Elections202 are designations of choices made by input user 108. Examples ofelections are choices to issue a Do Not Resuscitate Order or a choice ofa particular end-of-life condition response to a particular end-of-lifecondition, as will be discussed in more detail below.

FIG. 3 shows a basic set of administrative information 204. Privacyinformation 301 includes records necessary to assure the privacy of aparticipant and his choices. Security information 302, participantidentification parameter 303, and unique identification parameter 304include information necessary to assure that the system is secure fromintrusion and allows participants, authorized key persons, input users,and output users to gain access to information within bounds set by thesystem administration and participant 110.

Link to another participant 305 preferably records links to anotherparticipant that is a family member of participant 110. Link to anotherparticipant 305 can also link participants pairs wherein one participantappears as a key person in the other participant's information set.Payment account information 306, customer service note 307, and eventlog information 308 keep track of the billing records of participant110, interactions between customer service personnel and participant110, and any input user 108 activity, output user 128 activity, orinformation products 136 or 138 transmissions connected with informationset 118 corresponding to participant 110.

FIG. 4 shows types of end-of-life information 114 that input user 108can input through information input interface 112. Authorizations 401and 402 authorize a care giver responding to an end-of-life condition inparticipant 110 to act on a copy or a summary, respectively, of anoriginal document. The care giver is thus given permission to act inresponse to information products 136 or 138 which preferably includecopies or summaries of original executed documents. End-of-lifeinformation 403-405 includes designations of medications, allergies, orother health conditions related to participant 110 that could berelevant in choosing or administering an end-of-life condition responsefor participant 110.

End-of-life information 406 and end-of-life information 407 aredesignations of key persons, 407 referring to a medical professional tobe contacted in the event of an emergency or end-of-life condition.Emergency health information 408 includes, but is not limited to,important medical conditions such as emphysema, prescriptions taken,insurance coverage, and the names and telephone numbers of doctors andother key persons to contact if an end-of-life condition arises.

End-of-life choice 409 is shown in more detail in FIG. 5. End-of-lifechoice 409 includes, but is not limited to, a palliative care choice 501(the type, extent, and setting of symptom-relieving care when there isno hope for a cure), a comfort care choice 502 (the manner of and extentto which an unresponsive participant is maintained in comfort,preferably regardless of the chances for a cure), and a residence choice503 (specifying where and in what manner participant 110 should resideif long-term care is needed). End-of-life choice 409 may also bereligious 504 or spiritual 505 choice to assure that care will beconsonant with the religious or spiritual desires of participant 110.Likewise, end-of-life choice 409 may be a funereal or burial choicedesignating a type of funereal process such as burial, a location forburial, or specifying burial expenses. Non-medical end-of-life choice507 includes personal statements or directives to family, friends, orothers.

Advance directive 410 is detailed in FIG. 6. One type of advancedirective 410 is living will 601. A living will is a commandment byparticipant 110 to a key person 146 or another person to stop medicalcare when participant 110 is in a specified end-of-life condition. Thecommandment of living will 601 gives key person 146 or another person towhom the commandment is directed an obligation to carry out the will ofparticipant 110. The commandment leaves no discretion in the hands ofthe commanded person.

Medical power of attorney 602 (alternatively known as a health carepower of attorney) confers discretion over the end-of-life care ofparticipant 110 to a key person and authorizes many forms of end-of-lifecondition response when participant 110 is in an end-of-life condition.Medical power of attorney 602 can permit or require a key person 146 ofparticipant 110 to terminate medical care when participant 110 is in aspecified end-of-life condition.

Advance directive 410 may include a specific selection of an end-of-lifecondition response 603. (Some specific end-of-life conditions andend-of-life condition responses are shown in FIGS. 12 and 13,respectively.) More generally, advance directive 410 may include aselection of any medical treatment 604 or a refusal of any medicaltreatment 605.

Do-not-resuscitate order 411 is a specialized form of advance directivethat is signed by a physician of participant 110 and directs thatcertain life-prolonging treatments, usually including but not limitedto, cardiopulmonary resuscitation, not be administered.

End-of-life information 412 includes any document signed by a physicianof participant 110 concerning medical care associated with anend-of-life condition. Document 412 includes physician-signed documentsthat do not fit into the aforementioned categories.

Authorization to donate an organ 413 may be relevant in both emergentand non-emergent situations. Authorization 413 is a structureddirective, tailored to the needs of participant 110, to provide detailedinstructions for the harvesting of organs. Authorization 413 preferablyalso includes the granting of authority to key persons 146 toparticipate in the decisions about whether or not an organ should bedonated.

Output recipient information 414 assures the proper linkages betweeninformation products 136 or 138 and output recipients 142 and additionaloutput recipients 144 (preferably including key persons 146 and keyinstitutions 148). Output recipient information 414 identifies andincludes contact information and primary language designation for outputrecipient 140 and additional output recipients 142. Output recipientinformation 414 also preferably includes conditions, defined byparticipant 110, upon the fulfillment of which a given informationproduct 136 or 138 is to be transmitted to a given output recipient 140or additional output recipient 142.

The ability to determine the contents of information products 136 and138, the output recipients 140 and additional output recipients 142 ofinformation products 136 and 138, and the conditions required for thosetransmissions to occur gives participant 110 full control over the useof the invention and the end-of-life information in his information set118 in storage registry 120.

Enforcement information 415 preferably includes designations ofprospective enforcement jurisdictions. A prospective enforcementjurisdiction is a locality, either domestic or foreign, whichparticipant 110 foresees entering. A prospective enforcementjurisdiction may require special documentation or recognize only aspecialized version of an information product relevant for end-of-lifeconditions (for example, the required number of witnesses on certainadvance directives varies from state to state in the United States). Theinvention associates a prospective enforcement jurisdiction with acorresponding enforcement parameter that is applied to each informationproduct 136 or 138. The enforcement parameter assures that thejurisdictional requisites are met for end-of-life information ininformation set 118 and in information products 136 and 138. A primaryprospective enforcement jurisdiction may be designated either by inputuser 108 or an output user 128.

It will be understood that while the invention is capable of generatinginformation products that are customized for a particular jurisdiction,it contemplates the enforcement of information products in alljurisdictions that recognize such information products. Furthermore, aninformation product that is tailored to a particular jurisdictionsubstantially fulfills the enforcement requirements of all jurisdictionsthat recognize such an information product.

Enforcement information 415 preferably also includes a designation of aprimary language corresponding to a primary prospective enforcementjurisdiction or to a specifically anticipated output user 128 or outputrecipient 140 or 142. Accordingly, information product producer 134produces information products 136 and 138 having an information productlanguage that corresponds to the designated primary language. A primarylanguage may be designated by input user 108 or output user 128.Additional information product languages may be specified and linked toparticular anticipated output recipients 140 or 142.

Medical information 416 includes end-of-life information that may berelevant to either emergent or non-emergent end-of-life conditions.Medical information 416 generally refers to information generated bymedical treatment or analysis of participant 110 prior to activation ofthe invention in response to an end-of-life condition. Medicalinformation 416 may include, but is not limited to, a medical record, alaboratory report, a medical image, or a portion of the same. Similarly,a portion 417 of any end-of-life information items 401-416 may be storedin information set 118 in storage registry 120 when it is necessary forthe sake of convenience or efficiency.

FIG. 7 shows the elements 701-713 of information interface 112. Inputuser 108 can transmit end-of-life information to service component 102via any telecommunication device.

FIG. 8 shows information products 136 and 138. As discussed above,information products (such as 136) may incorporate raw data 200 or maybe substantially created or assembled by information product producer134 using elections 202 (forming an information product such as 138). Ingeneral, types of information products 136 and 138 correspond to theircorresponding end-of-life information sources. Accordingly, the types ofinformation products shown in FIG. 8 substantially correspond to theend-of-life information products shown in FIGS. 4-6 and described above.Information products include, but are not limited to, documents. Report819 is a report concerning an information set and may be used to polladministrative information 204 for official use or may be used toprovide output user 128 with an overview of the available informationproducts for participant 110.

FIG. 9 shows information output interface 130 devices and is similar toinformation input interface 112 devices shown in FIG. 7.

FIGS. 9 and 10 lists key persons and key institutions, respectively,that information input guide 104 preferably suggests be involved in theend-of-life planning process of participant 110. Key persons and keyinstitutions may also be designated as output recipient 140 oradditional output recipients 142.

FIG. 12 shows 8 broad categories of end-of-life conditions thatinformation input guide 104 preferably presents to input user 108 forpossible choice, as an election 202, for directing a correspondingend-of-life condition response. Central nervous system disorder 1201includes, but is not limited to, massive stroke, spinal cord injury orstroke causing permanent paralysis of limbs, progressive brain diseaseor injury such as Alzheimer's disease, severe progressive Parkinson'sdisease, and progressive degeneration of the nervous system such as LouGehrig's disease. Lung disease 1202 includes, but is not limited to,severe emphysema and chronic lung scarring. Heart/cardiovascular disease1203 includes, but is not limited to, chronic heart failure(unresponsive to drug therapy), massive heart attack, and chronic heartmuscle disease. Digestive disorder 1204 includes, but is not limited to,loss of extensive bowel from circulation failure, inflammatory diseaseor surgery, and progressive liver failure. Kidney disease 1205 includes,but is not limited to, chronic failure requiring a kidney machine tosustain life and severe acute kidney injury. Malignant disease 1206includes, but is not limited to, cancers inoperable or untreatable byaccepted medical guidelines, cancers spreading from one part of the bodyto other parts with no response to therapy, and associated consequencesof a cancer causing progressive failure of the central nervous system.Connective tissue disease 1207 includes, but is not limited to, lupusand other diseases which affect skin or muscle and become severe andprogressive in their final stages. Multiple organ failure 1208 may becaused, inter alia, by accidental injury or overwhelming infection.

It will be understood that the end-of-life conditions listed here arenot the only end-of-life conditions that can be addressed by theinvention. Advance directives aimed at end-of-life conditions of anytype and scope may be specified by input user 108 because the inventionis not limited to, the input, storage, and output of structured data andbecause participant 110 has control of the contents of information set118.

FIG. 13 shows end-of-life condition responses that participant 110 mayelect as part of an advance directive in the event of an end-of-lifecondition such as one of those listed above. Artificial breathing 1301,blood oxygenation 1302, blood circulation 1303, and renal functionspreferably involve using devices to take the place of respiratory,cardiac, and kidney functions, respectively. Radiation 1305 andchemotherapy 1306 preferably are employed to alleviate pain, contain, orcure malignant diseases. Organ transplantation 1307 preferably includes,but is not limited to, replacement of the heart, lungs, pancreas,gastrointestinal tract, kidney, or liver. Administration of nutrients1308 preferably involves the provision of tubes to supply food, water,and medications to the body when the gastrointestinal tract is notfunctioning.

FIG. 14 shows the two basic information storage registry formats.Standard information 1401 includes, but is not limited to, election 202.This may include, for example, selections of end-of-life conditionresponses to be included in an advance directive and responses to formsasking input user 108 for information such as emergency healthinformation 408 or output recipient information 414.

Non-standard information 1402 preferably includes, but is not limitedto, medical images such as x-rays and electronic copies of signeddocuments, such as a do-not-resuscitate order.

FIG. 15 shows the features of reference information interface 122.Reference information interface 122 preferably is an interface to anonline reference source or an interface to an intrinsic resource such asa file server or database. Reference information interface 122 providesinput user 108 with comparative information and analysis tools to makeinformed decisions about which types of end-of-life information 114 toregister in an information set 118. Reference information may include,but is not limited to: an electronic medical record 1501 correspondingto participant 110; guideline information 1502, medical protocol 1503,and physician's practice management program 1504, which are resourcesfrom the medical profession that report the best techniques availablefor treating prevalent medical conditions; and analysis tools 1505.

Analysis tools 1505 preferably allow input user 108 to obtainquantitative measures of outcomes for individuals with similar medicalhistories who experience a given end-of-life condition (outcomemeasurement 1506 and outcome prediction 1507). Treatment evaluation andcomparison 1508 and organ donation evaluation and comparison 1509 allowcomparisons of outcomes, merits, and risks between specific treatmentsfor a given end-of-life condition. Drug interaction analysis 1510 alertsinput user 108 to existing drug interaction dangers (assuming thatmedication information 403 is part of the information set 118 ofparticipant 110) and the potential danger based on any drug that mightbe administered in the course of an end-of-life condition response.

Disease and injury correlation analysis tool 1511 helps input user 108anticipate end-of-life planning needs and possible end-of-lifeconditions.

End-of-life choice analysis 1512 and end-of-life information productimplementation analysis 1513 provide information about participants'choices and experiences with end-of-life planning and actual responsesto end-of-life conditions to the medical community (for research andpractice). End-of-life choice analysis 1512 and end-of-life informationproduct implementation analysis 1513 preferably help educate the medicalcommunity and care givers about end-of-life planning and thus improvethe effectiveness of end-of-life planning for participants.

1. A computer-implemented method for generating an end-of-life healthcare information product, the method comprising: transmitting over anetwork to an information input interface an end-of-life health caremenu of choices associated with end-of-life guidance information;receiving over the network a selection of a choice from the end-of-lifehealth care menu of choices associated with the end-of-life guidanceinformation; receiving over the network participant end-of-lifeinformation associated with the selection of the choice from theend-of-life health care menu of choices; analyzing the receivedparticipant end-of-life information and the selected choice in light ofreference information to determine at least one available end-of-lifehealth care option; transmitting over the network the at least oneavailable end-of-life health care option; receiving over the network anelection from the at least one available end-of-life health care option;and transmitting over the network the end-of-life health careinformation product.
 2. The method of claim 1, wherein the participantend-of-life information comprises enforcement information, theenforcement information legally enforceable in a jurisdiction where theparticipant requires the end-of-life health care information product tobe utilized or where the participant resides.
 3. The method of claim 1,wherein the computer includes at least one processor that at leastpartially causes generation of the end-of-life health care informationproduct.
 4. The method of claim 1, wherein the reference information isselected from a group consisting of: a. an electronic medical record; b.guideline information; c. a medical protocol; d. a physician's practicemanagement program; e. at least a portion of a medical record; f. atleast a portion of a laboratory report; g. at least a portion of amedical image; and h. an analysis tool.
 5. The method of claim 4,wherein the analysis tool is selected from a group consisting of: a.outcome measurement; b. outcome prediction; c. treatment evaluation andcomparison; d. organ donation evaluation and comparison; e. druginteraction analysis; f. disease and injury correlation; g. end-of-lifechoice analysis; and h. end-of-life information product implementationanalysis.
 6. The method of claim 1, the method further comprising:transmitting a second end-of-life health care menu of choices associatedwith end-of-life guidance information.
 7. The method of claim 1, whereinthe participant end-of-life information comprises administrativeinformation.
 8. The method of claim 7, wherein the administrativeinformation is selected from a group consisting of: a. privacyinformation; b. security information; c. a participant identificationparameter; d. a unique identification parameter; e. a link to anotherparticipant; f. payment account information; g. a customer service note;h. event log information; i. primary place of residence; j. secondaryplace of residence; k. social security identification number; l.driver's license identification number; m. passport identificationnumber; n. annual income; o. a date of birth; p. gender; q. adesignation of at least one person to be contacted in case of anemergency; r. a designation of at least one physician; and s. healthcare insurance information.
 9. The method of claim 1, wherein theparticipant end-of-life information includes end-of-life informationselected from a group consisting of: a. an authorization to rely on acopy of an original document; b. an authorization to rely on a summaryof an original document; c. a designation of at least one medication; d.a designation of at least one allergy; e. a designation of at least onehealth condition; f. a designation of at least one person to becontacted in case of emergency; g. a designation of at least onephysician; h. emergency health information; i. an end-of-life choice; j.an advance directive; k. a Do-Not-Resuscitate Order; l. a documentsigned by a physician concerning medical care associated with anend-of-life condition; m. an authorization to donate an organ; n. outputrecipient information; o. enforcement information; p. medicalinformation; and q. a portion of an end-of-life item a-p.
 10. The methodof claim 1, wherein the end-of-life health care menu of choices includesa choice of an advance directive selected from a group consisting of: a.a living will; b. a health care power of attorney; c. a selection of anend-of-life condition response; d. a Do-Not-Resuscitate Order; e. anauthorization to donate an organ; f. a document signed by a health careprofessional concerning medical care associated with an end-of-lifecondition; g. a physician orders for life-sustaining treatment; h. amedical orders for life-sustaining treatment; i. a selection of medicaltreatment; and j. a refusal of medical treatment.
 11. The method ofclaim 1, wherein the end-of-life health care information productincludes information selected from a group consisting of: a. anauthorization to rely on a copy of an original document; b. anauthorization to rely on a summary of an original document; c. adesignation of at least one medication; d. a designation of at least oneallergy; e. a designation of at least one health condition; f. adesignation of at least one person to be contacted in case of emergency;g. a designation of at least one physician; h. emergency healthinformation; i. an end-of-life choice; j. an advance directive; k.output recipient information; l. enforcement information; m. medicalinformation; and n. a health care insurance information.
 12. The methodof claim 1, wherein the end-of-life health care menu of choices includesa choice of an end-of-life choice selected from a group consisting of:a. a palliative care choice; b. a comfort care choice; c. a residencechoice; d. a religious choice; e. a spiritual choice; f. a funeralarrangement choice; and g. a non-medical choice.
 13. The method of claim1, wherein the end-of-life health care menu of choices includes anend-of-life condition selected from a group consisting of: a. a centralnervous system disorder b. a lung disease c. a heart/cardiovasculardisease d. a digestive disorder e. a kidney disease f. a malignantdisease g. a connective tissue disease h. multiple organ failure; and i.other end-of-life condition.
 14. The method of claim 13, wherein theend-of-life heath care menu of choices includes an end-of-life conditionresponse selected from a group consisting of: a. artificial breathingsustenance b. artificial blood oxygenation c. artificial bloodcirculation d. artificial renal function e. radiation f. chemotherapy g.organ transplantation; and h. administration of nutrients.
 15. Themethod of claim 1, the method further comprising: storing in aninformation storage registry at least a portion of: a. the receivedchoice from the end-of-life health care menu; b. the participantend-of-life information associated with the selection of the choice; orc. the election from the at least one available end-of-life health careoption.
 16. The method of claim 15, wherein the information storageregistry is stored in a standard or a non-standard format.
 17. Themethod of claim 1, the method further comprising: providing to a medicalcommunity for research or practice at least a portion of: a. thereceived choice from the end-of-life health care menu; b. theparticipant end-of-life information associated with the selection of thechoice; or c. the election from the at least one available end-of-lifehealth care option.
 18. The method of claim 1, wherein the informationinput interface is selected from a group consisting of: a. a stationarytelephone; b. a portable telephone; c. a cellular telephone; d. a mobiletelephone; e. an interactive user interface accessible via an Internetconnection; f. a personal computer; g. a facsimile machine; h. a smartcard; i. a personal data assistant; j. a handheld computer; k. acomputer-to-computer link; l. a modem; m. a wireless transceiver; and n.voicemail.
 19. The method of claim 1, wherein the participantend-of-life information includes end-of-life information selected from agroup consisting of: a. raw data; and b. elections.
 20. The method ofclaim 1, wherein end of life health care information product comprises aparticipant identification instrument.
 21. The method of claim 20,wherein the participant identification instrument is selected from: a.an identification card b. a smart card; or c. a personal data assistant.22. The method of claim 1, wherein the participant end-of-lifeinformation may be stored in an electronically or electromagneticallyreadable format, an optically readable format, or in any otherappropriate format.
 23. The method of claim 1, wherein at least aportion of the end-of-life health care information product is providedto a medical community for research or practice.
 24. The method of claim1, the method further comprising: updating the reference information toinclude new or revised medical or legal information.
 25. The method ofclaim 1, the method further comprising: updating the end-of-life healthcare information product.
 26. A computer-implemented method forretrieval by an output user of an end-of-life health care informationproduct associated with a participant, the method comprising: receivingover a network an identification parameter associated with theparticipant; retrieving at least a portion of the end-of-life healthcare information product corresponding to the participant; andtransmitting over the network to the output user the retrieved portionof the end-of-life health care information product corresponding to theidentification parameter associated with the participant.
 27. The methodof claim 26, wherein the retrieved portion of the end-of-life healthcare information product is transmitted over the network to aninformation product output interface for use by the output user.
 28. Themethod of claim 26, wherein the retrieved portion of the end-of-lifehealth care information product is selected from a group consisting of:a. an electronic medical record; b. guideline information; c. a medicalprotocol; d. a physician's practice management program; e. at least aportion of a medical record; f. at least a portion of a laboratoryreport; g. at least a portion of a medical image; and h. an analysistool.
 29. The method of claim 28, wherein the analysis tool is selectedfrom a group consisting of: a. outcome measurement; b. outcomeprediction; c. treatment evaluation and comparison; d. organ donationevaluation and comparison; e. drug interaction analysis; f. disease andinjury correlation; g. end-of-life choice analysis; and h. end-of-lifeinformation product implementation analysis.
 30. The method of claim 26,the method further comprising: retrieving at least a second end-of-lifehealth care information product.
 31. The method of claim 26, wherein thehealth care end-of-life information product comprises administrativeinformation.
 32. The method of claim 31, wherein the administrativeinformation is selected from a group consisting of: a. privacyinformation; b. security information; c. a participant identificationparameter; d. a unique identification parameter; e. a link to anotherparticipant; f. payment account information; g. a customer service note;h. event log information; i. primary place of residence; j. secondaryplace of residence; k. social security identification number; l.driver's license identification number; m. passport identificationnumber; n. annual income o. a date of birth; p. gender; q. personalcontact information; r. medical contact information; and s. healthinsurance information.
 33. The method of claim 26, wherein theend-of-life health care information product includes participantend-of-life information selected from a group consisting of: a. anauthorization to rely on a copy of an original document; b. anauthorization to rely on a summary of an original document; c. adesignation of at least one medication; d. a designation of at least oneallergy; e. a designation of at least one health condition; f. adesignation of at least one person to be contacted in case of emergency;g. a designation of at least one physician; h. emergency healthinformation; i. an end-of-life choice; j. an advance directive; k. aDo-Not-Resuscitate Order; l. a document signed by a physician concerningmedical care associated with an end-of-life condition; m. anauthorization to donate an organ; n. output recipient information; o.enforcement information; p. medical information; and q. a portion of anend-of-life item a-p.
 34. The method of claim 26, wherein theend-of-life health care information product includes end-of-life healthcare information selected from a group consisting of: a. anauthorization to rely on a copy of an original document; b. anauthorization to rely on a summary of an original document; c. adesignation of at least one medication; d. a designation of at least oneallergy; e. a designation of at least one health condition; f. adesignation of at least one person to be contacted in case of emergency;g. a designation of at least one physician; h. emergency healthinformation; i. an end-of-life choice; j. an advance directive; k.output recipient information; l. enforcement information; m. medicalinformation; n. a long-term health care insurance policy; and o. healthinsurance information.
 35. The method of claim 26, wherein theend-of-life health care information product includes an advancedirective selected from a group consisting of: a. a living will; b. ahealth care power of attorney; c. a selection of an end-of-lifecondition response; d. a Do-Not-Resuscitate Order; e. an authorizationto donate an organ; f. a document signed by a health care professionalconcerning medical care associated with an end-of-life condition; g. aphysician orders for life-sustaining treatment; h. a medical orders forlife-sustaining treatment; i. a selection of medical treatment; and j. arefusal of medical treatment.
 36. The method of claim 26, wherein theend-of-life health care information product includes an end-of-lifechoice selected from a group consisting of: a. a palliative care choice;b. a comfort care choice; c. a residence choice; d. a religious choice;e. a spiritual choice; f. a funeral arrangement choice; and g. anon-medical choice.
 37. The method of claim 26, wherein the end-of-lifehealth care information product includes the participant's end-of-lifecondition selected from a group consisting of: a. a central nervoussystem disorder b. a lung disease c. a heart/cardiovascular disease d. adigestive disorder e. a kidney disease f. a malignant disease g. aconnective tissue disease h. multiple organ failure; and i. otherend-of-life condition.
 38. The method of claim 26, wherein theend-of-life heath care information product includes an end-of-lifecondition response selected from a group consisting of: a. artificialbreathing sustenance b. artificial blood oxygenation c. artificial bloodcirculation d. artificial renal function e. radiation f. chemotherapy g.organ transplantation; and h. administration of nutrients.
 39. Themethod of claim 26, wherein the end-of-life health care informationproduct is legally enforceable in a jurisdiction where the participantrequires the end-of-life health care information product to be utilizedor where the participant resides.
 40. The method of claim 26, whereinthe end-of-life health care information product is transmitted in alanguage understood by the output user.
 41. The method of claim 26,wherein the end-of-life health care information product output interfaceis selected from a group consisting of: a. a stationary telephone; b. aportable telephone; c. a cellular telephone; d. a mobile telephone; e.an interactive user interface accessible via an Internet connection; f.a personal computer; g. a facsimile machine; h. a smart card; i. apersonal data assistant; j. a handheld computer; k. acomputer-to-computer link; l. a modem; m. a wireless transceiver; and n.voicemail.
 42. The method of claim 26, the method further comprising:retrieving at least a second portion of the end-of-life health careinformation product corresponding to the participant; transmitting overthe network to the output user the retrieved second portion of theend-of-life health care information product corresponding to theidentification parameter associated with the participant.
 43. The methodof claim 26, wherein the retrieved portion of the end-of-life healthcare information product is in a form of a computer-generated documentor a summary of a document.
 44. The method of claim 26, the methodfurther comprising: providing guidance information to the output user.45. The method of claim 26, the method further comprising: receivingoutcome information about the participant after the retrieved portion ofthe end-of-life health care information product has been transmitted tothe output user.
 46. The method of claim 26, the method furthercomprising: providing to a medical community for research or practice atleast a portion of: a. the end-of-life health care information product;or b. outcome information about the participant.
 47. A system forgenerating an end-of-life health care information product, the systemcomprising: a processor; a computer readable storage medium havinginstructions for execution by the processor which causes the processorto generate the end-of-life health care information product; wherein theprocessor is coupled to the computer readable storage medium, theprocessor executing the instructions on the computer readable storagemedium to: transmit over a network to an information input interface anend-of-life health care menu of choices associated with end-of-lifeguidance information; receive over the network a selection of a choicefrom the end-of-life health care menu of choices associated with theend-of-life guidance information; receive over the network participantend-of-life information associated with the selection of the choice fromthe end-of-life health care menu of choices; analyze the receivedparticipant end-of-life information and the selected choice in light ofreference information to determine at least one available end-of-lifehealth care option; transmit over the network the at least one availableend-of-life health care option; receive over the network an electionfrom the at least one available end-of-life health care option; andtransmit over the network the end-of-life health care informationproduct.